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January 2021
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HHS Counters the 1914 Harrison Narcotics Act

After 107 years of drug war-induced misery and futility, the U.S Department of Health and Human Services (HHS) finally reversed the legal remnants of the 1914 Harrison Narcotics Act that prohibited general medical practitioners from treating patients addicted to drugs for their addictions. The HHS made history recently by changing 21 U.S.C. § 823(g)(2) of the Controlled Substances Act (CSA) so that physicians who want to prescribe buprenorphine to their patients for opioid use disorder (OUD) can do so without going to jail. The following restrictions must be met:

• The exemption only applies to physicians who may only treat patients who are located in the states in which they are authorized to practice medicine.
• Physicians utilizing this exemption will be limited to treating no more than 30 patients with buprenorphine for opioid use disorder at any one time (note: the 30 patient cap does not apply to hospital-based physicians, such as Emergency Department physicians).
• The exemption applies only to the prescription of drugs or formulations covered under the X-waiver of the CSA, such as buprenorphine, and does not apply to the prescription, dispensation, or use of methadone for the treatment of OUD.
• Physicians utilizing this exemption shall place an “X” on the prescription and clearly identify that the prescription is being written for opioid use disorders (along with the separate maintaining of charts for patients being treated for OUD).
• An interagency working group will be established to monitor the implementation and results of these practice guidelines, as well as the impact on diversion.

Under the new regulations, actual progress toward ending the drug war is achieved merely by engaging in a harm reduction-based approach that encourages medicinally-based therapies that see addictions as treatable illnesses. By allowing drug treatment to be administered by licensed and general medical practitioners, HHS sidestepped the NIMBY effect where people object to having a drug treatment center in their neighborhood or next to schools or businesses. Under U.S. medical privacy laws (HIPAA), the new regulations protect the privacy and dignity of the patient suffering from opioid addiction, making it more likely a person will seek treatment should they desire it.

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